Cardiology

Three-Month DAPT Non-Inferior to 12 Months After Firehawk Sirolimus DES, With Less Bleeding

In 2445 PCI patients treated with Firehawk sirolimus-eluting stents, 3-month DAPT was non-inferior to 12-month DAPT for the 18-month composite endpoint. Event rates were similar (10.1% vs 10.9%), with an absolute difference of -0.76% and upper one-sided 97.5% CI 1.70%, below the 3.5% margin. From 3 to 18 months, major bleeding was lower with 3-month DAPT (2.7% vs 4.4%; p=0.03) without an ischemic penalty reported. The open-label trial had lower protocol adherence in the 3-month arm and was limited to Firehawk stents in Chinese centers. 1

Calcium Channel Blockers Linked to Higher Aortic Aneurysm and Dissection Risk

Among 501,878 UK Biobank participants initially free of aortic aneurysm or dissection, calcium channel blocker use increased AAD risk versus untreated hypertensives (HR 1.31). In mouse AAD models, CCBs worsened aortic stiffness and aneurysm/dissection development, supporting a mechanistic link via impaired smooth muscle contractility. In patients with type B dissection undergoing endovascular repair, CCB therapy limited aortic regression relative to other antihypertensives. Silencing PRKG1 mitigated CCB-aggravated AAD progression in mice, implicating cGMP-dependent signaling and reinforcing biological plausibility. 2

Nirmatrelvir/Ritonavir Lowers Short- and Long-Term Cardiovascular Complications After COVID-19

This target trial emulation in hospitalized Hong Kong COVID-19 patients compared nirmatrelvir/ritonavir and molnupiravir with no antiviral for nine cardiovascular outcomes. Nirmatrelvir/ritonavir was associated with significantly lower one-year risks of cardiovascular mortality, composite cardiovascular complications, MACE, cerebrovascular events, and dysrhythmias versus controls. Molnupiravir reduced short-term (0–21 days) cardiovascular complications but offered only marginal long-term cardiovascular mortality benefit. Findings support preferential use of nirmatrelvir/ritonavir over molnupiravir in hospitalized, high-risk patients to attenuate post-acute cardiovascular sequelae. 3

Semaglutide Reduces Hospitalizations and Hospital Days in Obese Patients With Established CVD (SELECT)

In SELECT, 17,604 patients with established CVD, BMI ≥27, and no diabetes received semaglutide 2.4 mg weekly or placebo for a median 41.8 months. Semaglutide reduced total hospitalizations for any indication (18.3 vs 20.4 per 100 patient-years; MR 0.90; 95% CI 0.85–0.95; P<.001). Serious-adverse-event hospitalizations and hospital days were also lower with semaglutide (RR 0.89 for days; 95% CI 0.82–0.98; P=.01). Benefits were consistent across key subgroups, suggesting broad applicability in obese patients with established cardiovascular disease. 4